1. Ingenix InSite User Group August 10, 2010 Approval Code: IN187

2. © Ingenix, Inc. 2 Ingenix InSite User Group: Welcome Administrative Reminders:  This call is hosted in a listen only mode for participants until our Q&A segment.  Questions you may want to ask prior to the Q&A segment can be typed in our chat panel for the host to address  Please keep your phones on mute during Q&A.  The webex login password for this call is ‘insite’.  When logging into the webex please enter in your first and last name.  The user group presentation materials will be sent with the meeting minutes.  Ingenix InSite User Group Questions or Product Enhancement requests? Email ingenix.insite@ingenix.com.ingenix.insite@ingenix.com  Ingenix InSite Website Questions? Call or email the Ingenix Helpdesk 1-866- 818-7503 or client.support@ingenix.com.client.support@ingenix.com

3. © Ingenix, Inc. 3 Ingenix InSite User Group: Agenda  10:00 AM – 10:05 AMWelcome & InSite Operations Announcements  10:05 AM – 10:25 AM Focus on: Aneurysms  10:25 AM – 10:50 AMUsing InSite to Identify and “Work” Highest Suspected RAF Patients  10:50 AM – 11:00 AMQ & A

4. © Ingenix, Inc. 4 InSite Operations Announcements  Data Refresh Update –InSite data was refreshed August 9 th –Next data refresh targeting September 7 th  July 30 th 2010 – New InSite Release –Prevalence Report modification for filtering by health plan –Freeze column headers on reports, searches & custom lists –New Superbills for Nephrology & Pediatrics –July & August Ingenix Insider –Updated ICD-10 Link –InSite Compatibility with: Internet Explorer 7.0 Internet Explorer 8.0

5. Focus On: Aortic Aneurysm and Dissection and Other Aneurysm Mary Jo Groome, CCS-P, CPC-H Ingenix, Clinical Assessment Solutions

6. © Ingenix, Inc. 6 Aortic Aneurysm and Dissection An aneurysm is a localized abnormal dilation of blood vessels. A dissecting aneurysm is one in which blood enters the wall of the artery and separates the layers of the vessel wall. As the aneurysm progresses, tension increases and the aneurysm is likely to rupture, which usually results in death. In general, an aneurysm is considered clinically significant if its diameter is twice that of a normal artery.

7. © Ingenix, Inc. 7 Aortic Aneurysm and Dissection Risk factors for AAA include: 3 Male gender 65 years and older Smoking history Family history High cholesterol High blood pressure Other vascular disease Obesity

8. © Ingenix, Inc. 8 Aneurysms are diagnosed…  primarily by their location, such as: 1 –Aneurysm of coronary vessels 414.11 –Dissecting aneurysm of abdominal aorta 441.02 –Aneurysm of abdominal aorta with rupture 441.3 –Aneurysm of thoracic artery 441.2 –Ruptured aneurysm of thoracic artery 441.1 –Thoracoabdominal aneurysm wo mention of rupture 441.7

9. © Ingenix, Inc. 9 Thoracic vs Abdominal The aorta is first called the thoracic aorta as it leaves the heart, ascends, arches and descends through the chest until it reaches the diaphragm (the partition between the thorax and abdomen). The aorta is then called the abdominal aorta after it has passed the diaphragm and continues down the abdomen. The abdominal aorta ends where it splits to form the two iliac arteries that go to the legs.

10. © Ingenix, Inc. 10 Area of Study

11. © Ingenix, Inc. 11 Aortic Aneurysm and Dissection 441 Aortic aneurysm and dissection 1 441.0 Dissection of aorta (HCC104) DEF: Dissection or splitting of wall of the aorta; due to blood entering through intimal tear or interstitial hemorrhage 441.00 Unspecified site 441.01 Thoracic 441.02 Abdominal 441.03 Thoracoabdominal

12. © Ingenix, Inc. 12 Documentation Note If documentation identifies the abdominal aortic aneurysm as a Type I, Type II or Type III, the condition still classifies to 441.0x, Dissection of aorta. The fifth digit for this category identifies the site.

13. © Ingenix, Inc. 13 Aortic Aneurysm and Dissection 441 Aortic aneurysm and dissection 1 (cont) 441.1 Thoracic aneurysm, ruptured (HCC 104) 441.2 Thoracic aneurysm w/o mention of rupture (HCC 105) 441.3 Abdominal aneurysm, ruptured (HCC 104) 441.4 Abdominal aneurysm w/o mention of rupture (HCC105) 441.5 Aortic aneurysm of unspecified site, ruptured (HCC104)

14. © Ingenix, Inc. 14 Aortic Aneurysm and Dissection 441 Aortic aneurysm and dissection 1 (cont) 441.6 Thoracoabdominal aneurysm, ruptured (HCC 104) 441.7 Thoracoabdominal aneurysm, w/o mention of rupture (HCC105) 441.9 Aortic aneurysm of unspecified site w/o mention of rupture (HCC 105)

15. © Ingenix, Inc. 15 Other Aneurysm Includesaneurysm (ruptured) (false) (varicose) 1 aneurysmal varix Excludesarteriovenous aneurysm or fistula acquired (447.0) congenital (747.60-747.69) traumatic (900.0-904.9) 442.0 of artery of upper extremity 442.1 of renal artery 442.2 of iliac artery 442.3 of artery of lower extremity femoral or popliteal

16. © Ingenix, Inc. 16 Other Aneurysm cont 442.8 Of other specified artery 1 442.81 Artery of neck 442.82 Subclavian artery 442.83 Splenic artery 442.84 Other visceral artery 442.89 Other 442.9 Of unspecified site

17. © Ingenix, Inc. 17 Quick Facts  Between 5% and 10% of males ages 65-79 have an AAA. 2  A ruptured AAA is a medical emergency that carries an 85% to 90% mortality. 3  When an AAA reaches a diameter of 5cm, the risk of rupture is high enough that surgical repair (or possibly endovascular repair) should be initiated for individuals who are fit for surgery.,2,3,4  Smoking is the strongest independent risk factor-a lifetime history as few as 100 cigarettes is considered a smoking history. 5

18. © Ingenix, Inc. 18 References 1. World Health Organization. “2010 CCD-9-CM for Physicians-Volume 1 & 2, Expert.” St Paul MN: Ingenix Inc, 2009. Print 2. Cosford, PA, Leng. GC. Screening for abdominal aortic aneurysm. Cochrane Database of Systematic Reviews 2007, Issue 2, ART. No.: CD002945. DOI: 10.1002/14651858.2945.pub2. 3. Powell, JT Clinical Practice, “Small Abdominal Aortic Aneurysms.” New England Journal of Medicine 2003;348: 1895-1901. 4. Screening for Abdominal Aortic Aneurysms: Recommendation Statement.” US Preventive Services Task Force. Ann Intern Med 2005; 142: 198-202 5. Fillinger, M. “Screening for Abdominal Aortic Aneurysm: Recommendation Statement.” Perspect Vasc Surg Endovasc Ther 2006; 18: 71-83.

19. Using InSite to Identify and “Work” Highest Suspected RAF Patients Presented by: Pam Holt Regional Manager Market Consultation Southern California

20. © Ingenix, Inc. 20 Progress Report  Report shared during strategy meetings with groups  Outstanding patients with highest suspected RAF

21. © Ingenix, Inc. 21 Recommended Actions  Two separate projects based on DOS year 1.Outreach to patients 2.Chart Review  How to use InSite to identify these patients

22. © Ingenix, Inc. 22 Opportunity / Project # 1  Target high risk patients for outreach (2010) –Schedule extended visit to evaluate chronic conditions –Include PAF showing suspected conditions

23. © Ingenix, Inc. 23 CSI Report Identifies the Patients  Export the CSI report –Use “2010” filter for Outreach – Project # 1  Select the cells from Cell A4 – AD4 & down to bottom –All except the header rows (rows 1 – 3)  “Data” Sort by: 1.First: Column AD (“Combined Suspected HCC Factor”) - descending 2.Then by: Column F (“Member ID”) - ascending 3.Then by: Column C (“PCP”) – if applicable – ascending  Report will have highest suspected RAF at top

24. © Ingenix, Inc. 24 A little more work for Project # 1 …..  Export MWOV –Sort by Likelihood Very High High –Disregard any duplicates –Add Patients with Very High and High Likelihood from MWOV to the CSI list of patients to contact  Print Patient Assessment Forms (PAF) –For physician to use at time of visit Lists the suspected conditions for evaluation  Outreach to patients to schedule an extended appointment prior to end-of-year  Evaluate all chronic conditions, document & code

25. © Ingenix, Inc. 25 Opportunity / Project # 2  Focused chart review based on highest suspects –Coders review charts for documented conditions not coded (2009 DOS) –Complete an ASM Spreadsheet

26. © Ingenix, Inc. 26 Again…CSI Report Identifies the Patients  Export the CSI report –Use “2009” filter for Outreach – Project # 2  Select the cells from Cell A4 – AD4 & down to bottom –All except the header rows (rows 1 – 3)  “Data” Sort by: 1.First: Column AD (“Combined Suspected HCC Factor”) - descending 2.Then by: Column F (“Member ID”) - ascending 3.Then by: Column C (“PCP”) – if applicable – ascending  Report will have highest suspected RAF at top

27. © Ingenix, Inc. 27 Final Steps - Project # 2  Work from 2009 list to pull charts for review  Coders review charts for documentation not previously coded  Submit additional codes found via ASM Spreadsheet prior to January Sweep

28. © Ingenix, Inc. 28 Summary  Suspects from Progress Reports can be identified by using an exported CSI Report  Two separate projects –worked simultaneously –vary based on resources –impact both current and retrospective payment periods –prioritize based on potential RAF  It’s the perfect time of year to start these projects!

29. © Ingenix, Inc. 29 User Group Feedback Survey  We want your feedback!  Survey is to be sent immediately after this call

30. © Ingenix, Inc. 30 Question and Answer Approved: IN071